Salted with Sharks

Abandoned by the System

In On and off the Apron, Politics, Sunset on November 15, 2011 at 1:08 pm

The following story appeared in print issue 9 of the Elberta Alert.

By Emily Votruba

Janie Rosum and Kelly Beaton, with Kelly's buck, in better days. Photo courtesy of Janie Rosum.

KELLY BEATON WORKED as a welder for about 11 years at a shop in Honor, until he was laid off. He never had health care coverage as an adult and didn’t care much for going to the doctor. His longtime friend, Janie Rosum, remembers the morning when Kelly mentioned over the breakfast table that he might have a piece of metal in his eye. She took a look and immediately drove him to the ER. The piece of metal had been in his eye for two days.

Kelly wasn’t the type to ask for help from anyone. By the time he left the welding shop, he was feeling the damage done to his lungs on the job. When his unemployment ran out this past summer, he was already quite ill, but he kept working, picking up odd jobs here and there, mostly on construction sites.

Kelly was 50 years old and had never been part of the welfare or Medicaid system. He never married, never had children, and had few material things—no assets to speak of. He lived on Bigley Street in Elberta, in a trailer in his friend’s yard. One day in early September this year, he woke up with a terrible headache, the kind he couldn’t ignore. Janie took him to the ER. Janie feels that if Kelly had had any kind of health coverage and any regular medical attention, his illness would have been discovered long ago, perhaps in time for it to be successfully treated. As it was, on September 8, Kelly was diagnosed with four types of cancer—lung, liver, brain, and lymph node—at stage IV.

A couple of days later, Janie says, she gathered all of Kelly’s financial information and medical reports and headed down to the Benzie Government Office to apply for Medicaid for Kelly. What came next was a month and a half of unreturned phone calls and desperate measures that ultimately found Janie, bereaved of her friend, standing at the post office holding the first medical bill, for $23,000.

Janie is retired on disability herself and was Kelly’s sole caregiver from the time he got sick. Kelly’s parents are both alive but elderly and unwell, still mourning the death of Kelly’s younger sister ten months ago, and struggling to deal with that financial burden. Kelly moved into Janie’s house in Frankfort and she had his mail forwarded there. Unable to work and with no other income source, Kelly was forced to rely on Janie for everything. She used her own Bridge card to get him the nutritional supplements he needed as his weight plummeted by 60 pounds injust a few weeks. She drove him to doctor’s appointments, to the ER when he was struggling to breathe; to radiation treatments and chemo, and she paid for his nebulizer herself.

For weeks, Munson wouldn’t admit Kelly because he lacked insurance and had not been approved for Medicaid. He spent a night there once and was sent home the next day; nothing more could be done, they said. That visit alone cost over $10,000. All the while, Janie waited to hear back from DHS about Kelly’s Medicaid application. Janie says she had to fight to get Kelly the $12 oxygen tanks his doctor had ordered, several times paying for them herself. She says DHS would only approve one tank at a time, and one tank was not enough to last Kelly the trip to Traverse City and back. “A lot of the time I was making a mad dash to get him either back to the hospital or back to get another oxygen tank.” Finally, Janie says, the people at Biederman Cancer Center at Munson called the Prescription Shop after Kelly’s first radiation treatment and arranged for his oxygen-tank orders to come through.

Janie held a benefit spaghetti dinner for Kelly at the Mayfair Tavern on October 5, which raised $1,100. That money, so deeply appreciated, alas didn’t go very far. “We had to borrow money from everyone we knew. Ten pills was a hundred dollars,” Janie says.

At the beginning of October, Janie says, a couple of weeks after she first brought Kelly’s materials to Benzie’s DHS office, Kelly got a letter from his DHS caseworker, Andrew Lamb, denying him Medicaid. Janie says she’ll never forget how angry she felt when she opened that letter. The stated reasons according to Janie were that “he wasn’t under 21, he had no children living at
home, and they did not find that he was disabled.” Weak, breathless, in pain, and with an official stage IV cancer diagnosis, Kelly Beaton was not able-bodied by any reasonable definition. The man who had worked hard his whole life had at last reached the point where he could work no more. But the DHS offices in Benzie and Lansing apparently needed more convincing.

Janie continued to call DHS, demanding that they review Kelly’s case. “[The automated message] said if it’s an emergency, press this number. I pressed that number every time.” But she couldn’t get anyone to talk to her. Finally, at the beginning of October, she showed up at the Benzie County Government Office and refused to leave without a meeting.

“I kind of had to make a sneak attack. I casually walked in with the file and asked the first lady in the window if Andy Lamb was in his office. She told me he was and that I should call him from the extension phone on the wall. He didn’t answer. I walked back up to the window and told a gentleman there, ‘I know he’s in the building. This is an urgent situation, and I am not leaving until he comes out of his office and comes toe to toe, face-to-face with me.’” Janie says the caseworker finally came out and seemed not to know who she was. “And I said, ‘You know who I am, and you know the reason I’m here.’ And he opens up the file and he looks like it’s all new news to him. And I said, ‘What happened to his folder? I brought in a complete file weeks ago. Why can’t you get this through and make it happen?’ Then he opens up the first page and says, ‘Oh, this man is very ill.’ And I said, Really? No, this man is dying. And then he said, ‘Oh this is an emergency, I’ll take it right back and do something with it.’”

Days later, Janie received another letter saying Kelly had been denied. Somehow, he met none of the eligibility requirements.

Kelly was finally admitted to Munson at the end of October, for three days. During that time, a hospital social worker got DHS Benzie on the phone to find out why Kelly had been denied Medicaid. According to Janie the DHS rep gave the social worker “every excuse under the sun”—that Kelly’s paperwork was incomplete, that it hadn’t beensubmitted in a timely manner; that “he didn’t have an active case.” “I took everything to Andy Lamb weeks ago, the doctors orders and financial information, the chemo and radiation records…” She had watched him look at the file.

On October 27, at 1 pm, Kelly Beaton entered hospice care at Munson. He died at 6 pm. According to Janie he was in hospice for about two hours when the financial representative from Munson appeared, asking her how his bills were going to be paid.

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The denial of aid for Kelly, and the difficulty Janie and others in our community have had getting responses from caseworkers at DHS, have fueled rumors of staff and budget cuts at DHS, along with the suspicion that federal Medicaid money is somehow being dammed up at the state level. “It’s federal money,” Janie said. “[Michigan DHS has] no right to withhold it.”

I placed four calls in as many days to Andrew Lamb and supervisor Lois Kiehl, and got a voicemail message from Kiehl saying it was against DHS policy to talk to the press, and referring me to Benzie–Manistee DHS director Kristine Lagios, who returned my call promptly. According to Lagios, the Benzie staff has not only not been cut, but she has actually increased it during her tenure.

“That’s a bad rumor,” Lagios said. She explained that in October 2010 there were 6 assistant payments workers, 2 administrative support personnel, and a supervisor on staff at the Benzie office. Now the office is “at capacity,” she said, with 7 assistant payments workers, 1 migrant-program worker, 1 adult services worker, 4 children’s services workers, 2 administrative support staff, and two supervisors, for a total of 17. Some of these staff were brought from Manistee because Lagios perceived a need for them in our area.

Lagios wouldn’t comment on Kelly’s case specifically, citing confidentiality rules. “If it’s a case that qualifies, you would not be denied Medicaid,” Lagios said. “For example if you’re pregnant and meet the policy guidelines.” Different Medicaid programs have different eligibility rules, she said. As for cuts to Medicaid, Lagios knew of none currently, but did say there has been an “asset change” in the Food Assistance Program (FAP). She wouldn’t tell me what the asset change was, instead referring me to the state DHS website, where I found the following: “Asset Limit: Effective October 1, 2011 there is an asset limit for FAP groups.”

There was no elaboration on the limit or any links, so I called the number given under “Food Assistance Program Questions, call 1-855-ASK-MICH (1-855-275-6424).” After 30 minutes a rep answered. I identified myself as a member of the press and asked what the asset limit was for FAP groups. The rep directed me back to the Michigan DHS website, to “the Policies and Procedures page,” where she said I could download a booklet of information. I said, “Can’t you just tell me what the asset limit is?” She again referred me to the website. I said, “Is it different for different people or something?” She hung up on me.

A dense, small-font page on the DHS site lists administrative handbooks. I found the Bridges Eligibility Manual and clicked on it. A pdf appeared with a 5-page table of contents. On the website it says if you click on a table of contents item you’ll be taken to a page with information. None of the links I clicked on worked. I had no better luck finding the Medicaid eligibility requirements. I’m by no means the sharpest person on the planet, but I did graduate from a decent university. I can imagine a lot of people having trouble navigating this site, which the agency seems to rely on to “get the word out.” Sometimes you just really want to talk to a person.

A former executive of a health-related foundation in the state of Michigan, who did not wish to be named, said: “It’s really sad, but they almost always deny you Medicaid the first time you apply, no matter what. It’s not a policy, but it’s just the way the system goes. We always used to advise people, just reapply, reapply. And if necessary, get legal counsel.”

But Kelly Beaton did not have the luxury of time.

On the day before he died, Janie says, she opened a letter from DHS notifying Kelly that he would be receiving a Bridge card and $120 cash assistance per month. She was outraged. “I told Andy Lamb, ‘Dead people don’t eat much.’

“Medicaid was the most crucial thing,” she said, “because he didn’t want to leave us with that burden. But they didn’t give him that dignity in death.” Janie has had her own health problems. “I’m a diabetic heart patient. I damn near died. Kelly was there for me when I was sickest. It’s like with some of the elderly people I’ve taken care of—the runaround you get. It wasn’t [DHS’s] best friend, so what do they care?”

“Policy is not determined by the workers,” Lagios wrote in an e-mail. “Every case is treated the same and policy is followed
in making eligibility determinations. Disability determinations for Medicaid are not made locally. A packet is sent to Lansing and the determination is made by the Medical Review Team.”

Lagios said that if anyone has difficulty reaching their caseworker, they should contact the worker’s supervisor, at 231-882- 1330. “We’d like people to know that they can always check their case status online, and starting in January, you can apply for all assistance programs online.” Computer kiosks where people can check their benefits will eventually be put out in various areas, she noted.

The DHS website states: “Michigan has many health care programs available to children, families, and adults who meet certain eligibility requirements. The goal of these health care programs is to ensure that essential health care services are made available to those who otherwise would not have the financial resources to purchase them.” Michigan is not meeting that goal. If indeed Kelly Beaton’s case did not fall within any of the health care programs the state provides, we need a new program—one for mature single people who work their whole lives, pay their taxes, and then fall on very hard times. It can happen to any of us. And more and more often now, it does.

“Kelly was a strong-hearted man,” Janie says. “He’d do anything for his friends. He suffered more as he was dying because he was leaving behind these payments. My last promise to Kelly was that I would walk to the ends of this earth to make sure this verdict of denial was overturned. And I will never quit,” Janie said.

“I told him, ‘It’s all right, honey. You’ve already walked a lot of miles for me. I can do this for you.’” Ψ

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